System and methods with user interfaces for monitoring physical therapy and rehabilitation

ABSTRACT

A system for monitoring a joint of a patient includes multiple sensors to be disposed near a joint and to measure or observe actions or physical quantities associated with the joint; and at least one communications module coupled to the sensors to receive data from the sensors and to transmit sensor information to an external device. The system also includes a patient device and clinician device which can be used to, for example, monitor and display information obtained from the sensors, determine range of motion measurements from the sensor data, show progress in physical therapy, take a photograph or video of the site on the patient, obtain a pain score, and include friends for providing encouragement during physical therapy.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/422,320, filed Feb. 1, 2017, which issued as U.S. Pat. No.11,684,260, which is a continuation-in-part of U.S. patent applicationSer. No. 15/077,809, filed Mar. 22, 2016, which issued as U.S. Pat. No.10,709,377, which claims the benefit of both U.S. Provisional PatentApplication Ser. No. 62/136,892, filed Mar. 23, 2015, and U.S.Provisional Patent Application Ser. No. 62/136,925, filed Mar. 23, 2015,all of which are incorporated herein by reference in their entirety.

FIELD

The present invention is directed to the area of methods, systems, anddevices, including user interfaces, for monitoring physical therapy orrehabilitation. The present invention is also directed to systems andmethods with user interfaces for monitoring physical therapy orrehabilitation after surgery or implantation of an orthopedic device.

BACKGROUND

Joint replacement surgery is a common orthopedic procedure for jointssuch as the shoulder, hip, knee, ankle, and wrist. In situations wherethe patient has worn-out or damaged a joint, it is possible to replacethe joint with an implant that can merge with the skeletal structure andrestore pain free movement and function. Prior to implanting prostheticcomponents in a joint of a patient, a surgeon generally resects at leasta portion of the patient's native bone in order to create a platform,recess, or cavity for receiving at least a portion of the prostheticcomponents being implanted. During the process of implanting theprosthetic components muscles and tendons must be repositioned andreattached.

The patient must go through physical therapy in order to recover fromthis major surgery. The patient must exercise regularly as well as pushfor flexibility and balance in muscles that have been displaced. Whilethe goal is to have the patient extend their range of motion, there canbe an increased risk of falls or over-extension that can damage theimplant and injure the patient. If the patient does not push theirrehabilitation and achieve the needed range of motion, they will findthemselves with a stiff joint which may require an additional surgicaloperation (MUA—Manipulation Under Anesthesia) to achieve an adequaterange of motion to maintain their active lifestyle. Measuring ormonitoring the progress of the physical therapy can be problematic butis very useful for maintaining the patient's dedication andparticipation.

BRIEF SUMMARY

One embodiment is a system for monitoring a patient. The system includesa patient device configured and arranged for communication with a sensorunit disposed on or within the patient, the patient device including adisplay, a camera, a memory, and a processor coupled to the display,camera, and memory, wherein the processor is configured and arranged forperforming actions including: directing, on the display, a user to takea photograph or video of a site on the patient; upon receiving auser-input to take the photograph or video, taking the photograph orvideo; and storing the photograph or video in memory.

In at least some embodiments, the actions further include performing apigment analysis using the photograph or video to assess health of thesite on the patient. In at least some embodiments, the actions furtherinclude, when the pigment analysis indicates possible infection of thesite on the patient, producing a visual or audible warning to thepatient. In at least some embodiments, the actions further include, whenthe pigment analysis indicates possible infection of the site on thepatient, sending a message to a clinician device with an indication ofthe possible infection.

In at least some embodiments, the actions further include sending thephotograph or video to a clinician device for assessment of health ofthe site on the patient. In at least some embodiments, the photograph orvideo is a video and the actions further include assessing performanceof an exercise using the video. In at least some embodiments, theactions further include overlaying one or more lines or angles on thephotograph or video to represent position or movement of a limb of thepatient within the photograph or video.

Another embodiment is a system for monitoring a patient. The systemincludes a patient device configured and arranged for communication witha sensor unit disposed on or within the patient, the patient deviceincluding a display, a memory, and a processor coupled to the display,and memory, wherein the processor is configured and arranged forperforming actions including: directing, on the display, a user to inputa pain score; and sending the pain score to a clinician device.

In at least some embodiments, the actions further include receiving aselection by the user of an exercise; displaying, on the display, agraphical representation of the exercise and a user control which, whenactuated by the user, indicates that the user is performing theexercise; and, upon actuation of the user control, monitoring sensordata from the sensor unit to monitor performance of the exercise. In atleast some embodiments, the actions further include, during performanceof the exercise, display a count of repetitions of the exercise beingperformed. In at least some embodiments, the actions further include,during performance of the exercise, display either a current value or amaximum achieved value of a range of motion measurement associated withthe exercise, as determined from the sensor data.

In at least some embodiments, the actions further include receiving fromthe user a request for an exercise summary; and displaying, on thedisplay, a summary of a plurality of exercises indicating a number ofrepetitions performed for each exercise over a period of time. In atleast some embodiments, the actions further include receiving from theuser a request for a progress report for a range of motion measurement;and displaying, on the display, a graph of a plurality of values for therange of motion measurement obtained over a period of time. In at leastsome embodiments, the actions further include displaying, on thedisplay, a representation of a pathway to a goal for the range of motionmeasurement with an indication of current progress of the patient towardthat goal.

A further embodiment is a system for monitoring physical therapy of apatient. The system includes a patient device configured and arrangedfor communication with a sensor unit disposed on or within the patient,the patient device including a display, a memory, and a processorcoupled to the display, and memory, wherein the processor is configuredand arranged for performing actions including: directing, on thedisplay, a user to input one or more friends; sending a connectionmessage to each of the one or more friends; and receiving from at leastone of the one or more friends a message encouraging the patient tocontinue the physical therapy.

In at least some embodiments, the actions further include, in responseto user input, sending a message to at least one of the one or morefriends. In at least some embodiments, the actions further include, inresponse to user input, sending a challenge to at least one of the oneor more friends. In at least some embodiments, the actions furtherinclude sending a progress report to at least one of the one or morefriends, wherein the progress report includes an indication of progressby the patient toward at least one physical therapy goal. In at leastsome embodiments, the actions further include sending a progress reportto at least one of the one or more friends, wherein the progress reportincludes an indication of patient performance of at least one physicaltherapy exercise. In at least some embodiments, the progress reportfurther includes an indication of performance of the at least onephysical therapy exercise by at least one of the one or more friends.

Yet another embodiment is a method for performing the actions recitedfor any of the systems described above. A further embodiment is anon-transitory computer readable medium comprising instructions forperforming the actions recited for any of the systems described above.

BRIEF DESCRIPTION OF THE DRAWINGS

Non-limiting and non-exhaustive embodiments of the present invention aredescribed with reference to the following drawings. In the drawings,like reference numerals refer to like parts throughout the variousfigures unless otherwise specified.

For a better understanding of the present invention, reference will bemade to the following Detailed Description, which is to be read inassociation with the accompanying drawings, wherein:

FIG. 1 is a schematic diagram of one embodiment of a system formonitoring rehabilitation of a patient after implant surgery, accordingto the invention;

FIG. 2 is a schematic diagram of one embodiment of a computing devicefor use in the system of FIG. 1 , according to the invention;

FIG. 3A is a perspective side view of one embodiment of a sensor unitand a base disengaged from each other, according to the invention;

FIG. 3B is a side view of the sensor unit and base of FIG. 3A engagedwith each other, according to the invention;

FIG. 3C is a top view of the sensor unit and base of FIG. 3A engagedwith each other, according to the invention;

FIG. 4A is a top view of one embodiment of the sensor unit of FIG. 3A,according to the invention;

FIG. 4B is a side view of the sensor unit of FIG. 4A, according to theinvention;

FIG. 4C is an exploded view of the sensor unit of FIG. 4A, according tothe invention;

FIG. 4D is an exploded view of one embodiment of a housing of the sensorunit of FIG. 4A, according to the invention;

FIG. 5 is a diagram of one embodiment of a user interface for a mobiledevice to display a profile for a patient or clinician, according to theinvention;

FIG. 6 is a diagram of one embodiment of a user interface for a mobiledevice to display information obtained from a sensor unit, according tothe invention;

FIG. 7 is a diagram of another embodiment of a user interface for amobile device to display information obtained from a sensor unit,according to the invention;

FIG. 8 is a diagram of one embodiment of a user interface for a mobiledevice to display a range of motion measurement, according to theinvention;

FIG. 9 is a diagram of one embodiment of a user interface for a mobiledevice to display a summary of repetitions of exercises, according tothe invention;

FIG. 10 is a diagram of one embodiment of a user interface for a mobiledevice to display information obtained from a sensor unit, according tothe invention;

FIG. 11 is a diagram of one embodiment of a user interface for a mobiledevice to display selectable videos to demonstrate exercise, accordingto the invention;

FIG. 12 is a diagram of one embodiment of a user interface for a mobiledevice to set an exercise reminder, according to the invention;

FIG. 13 is a diagram of one embodiment of a user interface for a mobiledevice to display information obtained from a sensor unit and a pathwaytoward a physical therapy goal, according to the invention;

FIG. 14 is a diagram of yet another embodiment of a user interface for amobile device to display information obtained from a sensor unit,according to the invention;

FIG. 15 is a diagram of one embodiment of a user interface for a mobiledevice to set patient specific settings for a sensor unit, according tothe invention;

FIG. 16 is a diagram of one embodiment of a user interface for taking aphotograph or video, according to the invention;

FIG. 17 is a diagram of another embodiment of a user interface todisplay information obtained from a sensor unit, according to theinvention;

FIG. 18 is a diagram of a further embodiment of a user interface todisplay information obtained from a sensor unit, according to theinvention;

FIG. 19 is a diagram of yet another embodiment of a user interface todisplay information obtained from a sensor unit, according to theinvention;

FIG. 20 is a flowchart of one embodiment of a method of taking aphotograph or video of a site on the patient; according to theinvention;

FIG. 21 is a flowchart of one embodiment of a method of inputting a painscore; according to the invention;

FIG. 22 is a flowchart of one embodiment of a method for displayinginformation requested by the patient; according to the invention; and

FIG. 23 is a flowchart of one embodiment of a method for includingfriends in physical therapy; according to the invention.

DETAILED DESCRIPTION

The present invention is directed to the area of methods, systems, anddevices, including user interfaces, for monitoring physical therapy orrehabilitation. The present invention is also directed to systems andmethods with user interfaces for monitoring physical therapy orrehabilitation after surgery or implantation of an orthopedic device.

A system, as described herein, can be used to monitor physical therapyor the healing process or rehabilitation of the patient after surgery,as well as monitor or verify the extent of the patient's activity. Thesystem includes one or more sensors that can communicate with aprocessor that can produce information, based on the sensor readings anddata, that can facilitate the patient or another user, such as aclinician, doctor, physical therapist, nurse, care coordinator, or otherappropriate person, monitoring the patient's activity, the status of anorthopedic implant or surrounding tissues, or the effects ofrehabilitation or other therapy. It will be understood, however, thatthe systems, devices, and methods described herein can be used in thecontext of other surgeries or even rehabilitation or physical therapywithout surgical intervention. The sensors, described below, are placednear a physical therapy or rehabilitation site, such as a surgical siteor the body portion to be rehabilitated.

The system may also provide alerts if patient tissue becomes inflamed orif the effectiveness of, or compliance to, physical or rehabilitationtherapy is insufficient. The system includes a wearable device with oneor more sensors. For example, one or more sensors may be provided on awearable device that is applied to the skin of the patient.

In at least some embodiments, the one or more sensors communicate with asensor processor on the device containing the sensors. In at least someembodiments, the sensor processor, or, alternatively or additionally,the sensors, communicate with a processor of a patient device, such as amobile phone, tablet, computer or the like, or with a processor of aclinician device, such as a mobile phone, tablet, computer or the like.

FIG. 1 illustrates one embodiment of a system 100 for monitoring anorthopedic implant and rehabilitation after orthopedic replacementsurgery. The system 100 includes one or more sensors 102, an optionalsensor processor 104, a patient device 106 (such as a mobile phone,tablet, computer or the like), a clinician device 108, and a network 60.In at least some embodiments, the one or more sensors 102 and,preferably, the sensor processor 104 (or one or more of multiple sensorprocessors) are provided in a wearable device 112 that is external tothe patient such as, for example, a device that is applied to the skinof the patient or is carried in a brace or other article or textile thatis worn by the patient. Alternatively, one or more of the sensors 102and, optionally, the sensor processor can be implanted in the patient.In some embodiments, one or more of the sensors 102 are implanted and asensor processor and, optionally, one or more additional sensors areprovided in a wearable device.

Other embodiments of the system may include fewer or more componentsthan those illustrated in FIG. 1 , but the system typically includes thesensor(s) 102 and a processor (such as sensor processor 104, patientdevice 106, or clinician device 108) to communicate with the sensor(s)and provide information based on the sensor data. In the illustratedembodiment, the wearable device 112 includes the sensors 102 and sensorprocessor 104, but it will be understood that other sensors may beincluded that are not part of the wearable device 112. For example, oneor more additional sensors may be combined into another wearable devicethat may also include a sensor processor. It will also be understoodthat, in some embodiments, the wearable device 102 may not include asensor processor 104 or the sensor processor 104 may have limitedcapabilities (such as, for example, obtaining and transmitting sensorreadings without (or with limited) analysis of the sensor readings.

In FIG. 1 , the solid lines indicate communication between components inat least some embodiments of the system. Dotted lines indicatealternative or additional modes of communication between components. Inaddition to the communication illustrated in FIG. 1 , in at least someembodiments, the sensor processor 104 or sensors 102 may alsocommunicate directly with the clinician device. Communications caninclude, but is not limited to, wireless communication, wiredcommunication, optical communication, ultrasonic communication, or thecombination thereof. Satellite communication, cellular communication,Bluetooth™, near field communications (NFC), Infrared Data Associationstandard (IrDA), wireless fidelity (WiFi), and worldwideinteroperability for microwave access (WiMAX) are non-limiting examplesof wireless communication that can be used for communications. Ethernet,digital subscriber line (DSL), fiber to the home (FTTH), and plain oldtelephone service (POTS) are non-limiting examples of wiredcommunication that can be used for communications.

The network 60 can be any suitable type of network including, but notlimited to, a personal area network (PAN), local area network (LAN),metropolitan area network (MAN), wide area network (WAN), the Internet,or any combination thereof. In at least some embodiments, the network 60can be bypassed to provide direct connection between components. It willbe understood that other devices, such as a server or server farm,memory storage device, or the like can be connected to the patientdevice 106 or clinician device 108 through the network 60 or directly.For example, a server may be coupled to the patient device 106 orclinician device 108 that stores patient or other medical information,applications, user interfaces, a web interface, or the like for accessby the patient device 106 or clinician device 108.

The patient device 106 and the clinician device 108 can be any of avariety of devices, such as computers (for example, a notebook computer,a mobile medical station or computer, a server, a mainframe computer, ora desktop computer), mobile devices (for example, a cellular phone orsmartphone, personal digital assistant, or a tablet), or any othersuitable device. In at least some embodiments, the clinician device 108can be incorporated into a medical station or system.

FIG. 2 illustrates one embodiment of a computing device 201 for use asthe patient device 106 or clinician device 108. The computing device 201includes a processor 214, a memory 216, a display 218, and an inputdevice 220. The computing device 201 can be local to the user or caninclude components that are non-local to the computer including one orboth of the processor 214 or memory 216 (or portions thereof). Forexample, in some embodiments, the user may operate a terminal that isconnected to a non-local processor or memory.

The computing device 201 can utilize any suitable processor 214including one or more hardware processors that may be local to the useror non-local to the user or other components of the computing device.The processor 214 is configured to execute instructions provided to theprocessor. Such instructions can include any of the steps of methods orprocesses described herein.

Any suitable memory 216 can be used for the computing device 214. Thememory 216 illustrates a type of computer-readable media, namelycomputer-readable storage media. Computer-readable storage media mayinclude, but is not limited to, nonvolatile, non-transitory, removable,and non-removable computer-readable media implemented in any method ortechnology for storage of information, such as computer readableinstructions, data structures, program modules, or other data. Examplesof computer-readable storage media include RAM, ROM, EEPROM, flashmemory, or other memory technology, CD-ROM, digital versatile disks(“DVD”) or other optical storage, magnetic cassettes, magnetic tape,magnetic disk storage or other magnetic storage devices, or any othermedium which can be used to store the desired information and which canbe accessed by a computing device.

Communication methods provide another type of computer readable media;namely communication media. Communication media typically embodiescomputer-readable instructions, data structures, program modules, orother data in a modulated data signal such as a carrier wave, datasignal, or other transport mechanism and include any informationdelivery media. The terms “modulated data signal,” and “carrier-wavesignal” includes a signal that has one or more of its characteristicsset or changed in such a manner as to encode information, instructions,data, and the like, in the signal. By way of example, communicationmedia includes wired media such as twisted pair, coaxial cable, fiberoptics, wave guides, and other wired media and wireless media such asacoustic, RF, infrared, Bluetooth™, near field communication, and otherwireless media.

The display 218 can be any suitable display device, such as a monitor,screen, display, or the like, and can include a printer. The inputdevice 220 can be, for example, a keyboard, mouse, touch screen, trackball, joystick, voice recognition system, camera, microphone, or anycombination thereof, or the like.

Returning to FIG. 1 , the sensor processor 104 can be any suitableprocessor including one or more hardware processors. The sensorprocessor 104 is configured to execute instructions provided to theprocessor. The sensor processor 104 is configured to receive sensor datafrom the sensor(s) and communicate with the patient device 106, network60, clinician device 108, or any combination thereof. Optionally, thesensor processor 104 may also process or analyze the sensor data and mayhave instructions stored thereon to perform such processing or analysisincluding, for example, instructions to perform the steps of any of theprocessing or analysis described herein. In at least some embodiments,one or more of the sensor(s) 102 can each include a processor thatperhaps some or all of the functions of the sensor processor 104.

The one or more sensors 102 are provided to monitor an orthopedicimplant and surrounding tissue or monitor rehabilitation afterorthopedic surgery whether an implant was required or not, or to providepreparatory therapy in advance of a surgery, or any combination thereof.This disclosure will use an orthopedic knee implant as an example, butit will be understood that other joint implants, such as, for example,implants for the shoulder, hip, ankle, wrist, or any other joint, or anyother orthopedic device, such as an orthopedic spinal implant, whetherjoint replacement, joint resurfacing, soft tissue reconstruction,debridement, limb correction surgery, ligament replacement, or the like.

Any suitable type of sensor 102 can be used including, but not limitedto, accelerometers, magnetometers, gyroscopes, proximity sensors,infrared sensors, ultrasound sensors, thermistors or other temperaturesensors, cameras, piezoelectric or other pressure sensors, sonarsensors, external fluid sensor, skin discoloration sensor, pH sensor,microphone, or the like or any combination thereof. In at least someembodiments, the system 100 includes at least one, two, three, four,five, six, or more different types of sensors 102. The system mayinclude at least one, two, three, four, five, six, eight, ten, or moresensors 102. Further examples of suitable sensors and their arrangementand use can be found at U.S. patent application Ser. Nos. 15/077,809 and15/077,793 and U.S. Provisional Patent Applications Ser. Nos. 62/136,892and 62/136,925, all of which are incorporated herein by reference.

The one or more sensors 102 can be used to measure, monitor, orotherwise observe one or more aspects of the orthopedic device,surrounding tissue, or patient activity, or the like. The following areexamples of observations or measurements that can be made or interpretedusing one or more of the sensors: number of steps, repetitions of anexercise, repetitions of joint movement (e.g., joint pivoting), type ofexercise being performed, or other actions; stability, or lack thereof;flexion angle or range of motion; rate of motion; temperature of skin;pulse or pulse profile or heart rate recovery time after activity;ultrasound images, flow measurements, or Doppler measurements; sonarimages, flow measurements, or Doppler measurements; pressure or loadbearing measurements; detection of a limp or body orientation (e.g.,subluxation, posture, scoliosis) or a change in body orientation; jointshock or impact monitoring; sleep profile or rest duration; gaitanalysis, body/limb/joint alignments; or the like. A system 100 canobserve or measure one or more of these items or any combination of theitems.

The following provides further details on some of these measurements orobservations. One or more sensors (for example, accelerometers,gyroscopes, magnetometers, proximity sensors, or the like) may countsteps or repetitions of an exercise or number of joint movements orother actions experienced by the sensor, and may be utilized todetermine what type of exercise or movement is occurring. This can beused, for example, to monitor patient activity, monitor compliance withexercise therapy, or monitor possible signs of pain or other conditionsthat may hinder or aid rehabilitation. The sensor data may also be usedto monitor changes in activity or trends in activity.

One or more sensors (for example, accelerometers, gyroscopes,magnetometers, proximity sensors, or the like) may sense or detect orcompute the range of motion of the sensor, joint, or other portion ofthe patient body or the flexion of the joint. This can be used, forexample, to monitor patient rehabilitation, patient activity, monitorcompliance with exercise therapy, or monitor possible signs of pain orother conditions that may hinder or aid rehabilitation. These sensors orother sensors may be used to monitor shock to, or impact on, theorthopedic device or tissue around the orthopedic device. The sensordata may also be used to monitor changes in range of motion or flexionor trends in range of motion or flexion.

As an illustrative example, one or more accelerometers can measure theacceleration from joint movement. A ratio of measured accelerationbetween accelerometers of known distance apart can be used to assess thejoint movement and region of motion or flexion by calculating the centerof rotation about which the device is being rotated. This informationcan be used for the same purposes as described in the preceding example.

In another illustrative example, 1) an accelerometer and 2) a gyroscopeor magnetometer (which indicates direction relative to magnetic north)can be used to measure range of motion, rate of motion, number ofrepetitions, or the like. This information can be used for the samepurposes as described in the preceding two examples.

In another illustrative example, a single sensor such as anaccelerometer, gyroscope, or magnetometer can be used to measure orotherwise observe range of motion, rate of motion, number ofrepetitions, or the like. In at least some embodiments, thesemeasurements or other observations are determined using the sensor dataand one or more assumptions about the sensor or sensor data based on,for example, the recognition of patterns in the sensor data, the upperand lower limits of the range in the data collected, or the like. Suchinformation can be used in a manner similar to that in the precedingthree examples.

One or more sensors (for example, thermistors or infrared sensors) maysense or detect or compute a temperature or a change in temperature or atemperature trend. The temperature may be a skin temperature or ambienttemperature. The temperature measurements may be used, for example, toindicate the possibility of inflammation or pain or another conditionthat may hinder rehabilitation or patient health. The temperaturemeasurement may also be used, for example, to monitor if icing is beingperformed effectively, which can help reduce inflammation and aidhealing. These sensors may also or alternatively be used to sense,detect, or measure a pulse, a change in pulse, trends in the patient'spulse, a pulse profile, or heart rate recovery after patient activity(such as exercise or other exertion).

One or more sensors (for example, ultrasound or sonar sensors or camerasor the like) can sense or detect or compute particles or density ofparticles or a particle density trend. These sensors may also be used tosense the tissue surrounding the orthopedic device, detect wear ordimensional changes on the orthopedic device or surrounding tissue, orthe like. Ultrasound and sonar sensors may also be used to determine howclose other parts of the knee (or other joint) are to the implant.

One or more sensors (for example, piezoelectric, strain gage, or otherpressure or load bearing sensors) can sense or detect or computepressure or load with or around the sensor or orthopedic device. Thesensor data may also be used to monitor changes in range of pressure orload bearing or trends in pressure or load bearing. These sensors orother sensors may be used to monitor shock to, or impact on, theorthopedic device or tissue around the orthopedic device. A pressure orload bearing sensor may also be used to detect swelling of the tissuearound the orthopedic implant. Multiple pressure or load bearing sensorsmay also be used to detect flexion (which may be indicated by a uniaxialstretching of the tissue) and swelling (which may be indicated bybiaxial stretching of the tissue.)

U.S. patent application Ser. Nos. 15/077,809 and 15/077,793 and U.S.Provisional Patent Applications Ser. Nos. 62/136,892 and 62/136,925, allof which are incorporated herein by reference, describe examples ofsensors (including arrangements with implantable sensors), systems,devices, and methods for monitoring rehabilitation. Further examples ofsensors and their use can be found in U.S. patent application Ser. No.15/422,312 and U.S. patent application Ser. No. 15/422,299, both ofwhich were filed on Feb. 1, 2017 and incorporated herein by reference.

Power can be provided to the sensors 102 and optional sensor processor104 using any suitable power source including, but not limited to,primary cells, rechargeable batteries, storage capacitors, other powerstorage devices, or the like or any combination thereof. In someembodiments, the power can be provided by a kinetic energy power sourcethat utilizes the movements of the patient's body to generate power forthe components or to or to charge a battery or storage capacitor orother power storage device coupled to the components. In someembodiments, wireless power sources can be used in place of (or inaddition to) the battery, storage capacitor, or other power storagedevice.

In addition, a charging port can be provided for charging the battery orstorage capacitor or other power storage device from a source such as awall socket. Alternatively or additionally, wireless charging systemsand methods can also be used. It will be understood that in someembodiments there may be multiple methods for providing power to thecomponent or to a power storage device associated with the component.All of the sensors and optional sensor processor may be coupled to thesame power source or some of the sensors (or even all of the sensors)and sensor processor may have individual power sources.

In at least some embodiments, the sensors and optional sensor processorcan be active at all times to measure, monitor, or otherwise observe. Inother embodiments, one or more of the sensors and optional sensorprocessor can be active periodically (with a period of, for example, 15or 30 seconds or 1, 5, 10, 15, or 30 minutes or 1, 2, 3, 4, 6, 7, or 24hours) or randomly to measure, monitor, or otherwise observe.Optionally, the period may be programmable. In addition, the period maybe optionally altered based on data from one or more of the sensors. Inyet other embodiments, one or more of the sensors and optional sensorprocessor may be activated manually or automatically by the sensormodule, patient device, clinician device, or other device. In at leastsome embodiments, the sensors and optional sensor processor may havedifferent activation schedules (continuous, periodic, random, ormanual). For example, a sensor to measure temperature may do soperiodically, a sensor to measure number of steps or movement of thejoint may be continuous, and a sensor to measure range of motion may beactivated manually by the wearable device, patient device, or cliniciandevice when the patient performs rehabilitation exercises.

The systems and methods will be described herein with reference to anorthopedic knee implant or other knee surgery. Similar systems andmethods can be used with other joints including, but not limited to, thefinger joint, wrist joint, elbow joint, shoulder joint, hip joint, anklejoint, or toe joint. The systems and methods can be used to monitorphysical therapy for any reason including, but not limited to,rehabilitation associated with other treatments including treatments forligament or fracture surgery.

FIGS. 3A-3C illustrate one embodiment of a wearable device 312 thatincludes a sensor unit 322 and a base 324. The sensor unit 322 isremovable from the base 324, as illustrated in FIG. 3A. The wearabledevice 312, as illustrated in FIGS. 3B and 3C, is disposed on thepatient's skin with the base 324 adhered to the skin.

The base 324 includes a flexible receiving shell 326, a magnet 328, anoptional opening 330 for a temperature sensor, an optional tab 332,adhesive disposed on a bottom surface 334 of the shell, and an optionalmagnet holder 336 disposed on the shell. The magnet 328 of the base 324magnetically attaches to a similar magnet 354 (FIG. 4C) in the sensorunit 322 when the sensor unit 322 is attached to the base 324. Themagnets 328, 354 are intended to maintain attachment of the sensor unit322 to the base 324 during normal activity, exercise, and other physicaltherapy unless a patient or other person disengages the sensor unit fromthe base. Optionally, a magnet holder 336 fits over (entirely or only aperimeter of) the magnet 328 to hold the magnet to the shell 326.

In at least some embodiments, the shell 326 of the base 324 issufficiently flexible for adhesion to the skin of a patient as thepatient moves during normal activity or physical therapy exercises. Theshell may be made of any suitable material including, but not limitedto, flexible plastics such as silicone or polyurethane.

The shell 326 may also removably grip the sensor unit 322 to providefurther maintenance of the attachment of the sensor unit to the base324. In the illustrated embodiment, the shell 326 defines a receivingcavity 338 with sidewalls 340 around the cavity and a rim 342 around thesidewalls. In operation, the shell 326 receives a portion of the sensorunit 322, as illustrated in FIGS. 3B and 3C. In some embodiments, thesidewalls 340 or rim 342 may be resiliently flexible to expand when theportion of the sensor unit 322 is received in the cavity 338 and thencompress against a perimeter of the received portion of the sensor unit322. Preferably, at least the rim 342 or sidewalls 340 (or both) of thebase 324 are made of a material that grips the sensor unit 322 byadhesion, compression, or the like or any combination thereof. In atleast some embodiments, the sensor unit 322 may have a groove 390 thatcan receive the rim 342 to further facilitate maintaining the attachmentof the sensor unit to the base 324. In at least some embodiments, thesidewalls 340 slope outwardly and downwardly from the rim 342 to form anundercut region below the rim. The sensor unit 322 can be similarlyformed with a sloping housing to fit in the undercut below the rim 342of the base 324 to further facilitate maintaining engagement between thesensor unit and the base. It will be recognized that in addition or asan alternative to the magnets (or magnet and magnetically attractedmaterial) any other suitable type of mechanical fastener can be used tofasten the sensor unit 322 to the base 324.

The adhesive can be applied to the base 324 or can be an adhesivedisposed on two sides of a substrate with one side of the substrateadhered to the base 324. Preferably, the adhesive is selected to bewater resistant and resist losing adherence due to contact with sweat.In at least some embodiments, the base 324 or the adhesive on the baseis intended for use for at least one, two, three, five, seven, or tendays or two, three, or four weeks or more under normal usage conditionsbefore replacement or reapplication of adhesive. In at least someembodiments, the adhesive is selected to maintain adhesion to the skinwhen the user takes a shower. In at least some embodiments, the adhesiveis selected to maintain adhesion to the skin when the user takes a bath,swims in a pool, or sits in jacuzzi, hot tub, or rehabilitation pool.

The base 324 optionally includes a tab 332 disposed at any suitableposition relative to the shell 326. The tab 332 can facilitate removalof the sensor unit 322 from the base 324 by pushing or pulling on thetab 332 to deform the shell 326 to free the sensor unit. Preferably,operation of the tab 332 to disengage the sensor unit 322 can beperformed while maintaining attachment of the base 324 to the skin ofthe patient. In some embodiments, operation of the tab 332 can alsofacilitate engagement of the sensor unit 322 with the base 324.

FIGS. 4A-4C illustrate one embodiment of a sensor unit 322. Theillustrated sensor unit 322 includes an upper housing 350, a lowerhousing 352, a magnet 354, an electronics assembly 356, a power source358, a light emission arrangement 360, and adhesive 362, 364. Inaddition, in some embodiments, as illustrated in FIG. 4D, the upperhousing 350 can include a main housing 366 and a gripping element 368.In some embodiments, the sensor unit 322 can include more or fewercomponents than those illustrated in FIGS. 4A-4D.

The upper housing 350 and lower housing 352 form a cavity within whichat least the electronics assembly 356 and power 358 source reside. Theupper housing 350 and lower housing 352 can be made of any suitablematerial, such as metal or plastic materials (preferably, rigid plasticmaterials) or any combination thereof. In at least some embodiments, theupper housing 350 and lower housing 352, as well as the joining of theupper housing to the lower housing, are water resistant to resistingress of water, sweat, rain, and other fluids into the interior of thehousing. In at least some embodiments, the sensor unit 322 issufficiently water resistant to allow the patient to shower without anycovering over the sensor unit. In some embodiments, the sensor unit 322is sufficiently water resistant to allow the patient to bathe or swimwithout any covering over the sensor unit.

The optional gripping element 368 can have a roughened or otherwisenon-smooth surface on at least a portion of the gripping element. Thisnon-smooth surface facilitates gripping of the sensor unit 322,particularly for engaging or disengaging the sensor unit from the base324. In the illustrated embodiment, the gripping element 368 is aseparate element that is overmolded, adhered, or otherwise attached tothe main housing 366. The gripping element 368 may be made of adifferent, more flexible material than the main housing 366, such assilicone or polyurethane. In other embodiments, the gripping element 368is formed as part of the main housing 366 by roughening or otherwisemaking at least a portion of the surface of the main housing non-smooth.

The magnet 354 is arranged for magnetically coupling to the magnet 328of the base 324. In some embodiments, one of the magnets 354, 328 can bereplaced with a magnetically attracted material that will then couplewith the other magnet 354, 328 to magnetically coupled the base 324 tothe sensor unit 322. In the illustrated embodiment, the magnet 354 isattached to the lower housing 352 by adhesive 364 which can be a layerof adhesive or adhesive disposed on both sides of a substrate. In otherembodiments, the magnet 354 may be attached to the lower housing 352 byany other suitable method or may be disposed within the cavity formed bythe upper housing 350 and lower housing 352.

The power source 358 can be any suitable power source. For example, thepower source 358 can be a primary cell (e.g., a battery) and may have anexpected lifetime, under normal usage, of at least 7, 10, 20, 30, 60,90, 100, 70, or 180 days or more. In some embodiments, the primary cellmay be replaceable. In some embodiments, the power source 358 isrechargeable using, for example, a recharge port or an inductiverecharge device (such as an inductive mat or sleeve), or using WiFi orultrasonic charging or any other suitable recharging method. In someembodiments, the primary cell (e.g., battery) can be the magneticallyattractive material that the magnet 328 of the base 324 can bemagnetically coupled to.

The electronics assembly 356 can contain any suitable components foroperation of the sensor unit 322. In the illustrated embodiment, theelectronics assembly 356 comprises a circuit board 368, a sensorprocessor 304, a temperature sensor 370, an accelerometer 372, at leastone LED 374, a communications arrangement 376, and a magnetic switch378. Adhesive 362 can couple the circuit board 368 to the lower housing352. Other adhesive (not shown) may couple the circuit board or othercomponents to the upper housing 350.

The sensor processor 304 can be similar to the sensor processor 104described above and may have more or fewer capabilities than that sensorprocessor 104. In some embodiments, the sensor processor 304 may includeanalysis algorithms for analyzing or partially analyzing the sensordata. In other embodiments, the sensor processor 304 may be primarilydesigned to receive, store, and transmit sensor data.

The illustrated sensor unit 322 includes a temperature sensor 370 and anaccelerometer 372, but other embodiments can contain more or differentsensors, in any suitable combination, as described above. In theillustrated embodiment, the temperature sensor 370 is a thermistor whichextends away from the circuit board 368 and through an opening 366 inthe lower housing 352. When the sensor unit 322 engages the base 324, aportion of the temperature sensor 370 extends through the opening 330 inthe base 324 so that the temperature sensor 370 is exposed to the skinof the patient and may be in contact with the skin of the patient.

The communications arrangement 376 operates with the sensor processor304 to communicate with patient or clinician devices or other devices,as described above. Any suitable communications method or protocol canbe used including, but not limited to WiFi, Bluetooth™, near fieldcommunications, infrared, radio frequency, acoustic, optical, or thelike.

In some embodiments, the electronic assembly 356 also includes amagnetic switch 378, such as a reed switch, that is coupled to thesensor processor 304 so that when positioned near the magnet 328 of thebase 324 is actuated to place the sensor unit 322 in an active mode. Inat least some embodiments, when the sensor unit 322 is removed from thebase 324 the magnetic switch is actuated to place the sensor in aninactive or standby mode. Alternatively or additionally, the sensor unit322 may include a button, mechanical switch, or other mechanism to placethe sensor into the active mode or into an inactive or standby mode orto toggle between modes or to turn the sensor unit on or off. Also,alternatively or additionally, the sensor unit 322 may be placed intothe one of these modes (or toggled between modes) using signals from apatient or clinician device or other device communicating with thesensor unit 322. In at least some embodiments, in the inactive orstandby mode, the sensor unit 322 continues to be receptive to signalsfrom an external source (such as the patient or clinician device). In atleast some embodiments, in the inactive or standby mode, the sensor unit322 also maintains an internal clock.

The at least one LED 374 is coupled to the light emission arrangement360 to provide light to the light emission arrangement. In at least someembodiments, the light emission arrangement 360 includes a light emitter380 and a light pipe 382 to direct light from the LED(s) 374 to thelight emitter. The light emission arrangement 360 provides an indicationof operation of the device to a user or patient. For example, the lightemission arrangement 360 may be lit when the sensor unit 322 isoperating or is in the active mode. In some embodiments, the color oflight emitted by the light emission arrangement may indicate which mode(active or inactive/standby) the sensor unit is currently in or mayindicate operations being performed by the sensor unit (for example,transmitting, sensing, not sensing, synching with a patient or cliniciandevice, or the like). In some embodiments, instead of, or in additionto, color, flashing of the light or brightness of the light may be usedto indicate mode or operations. As an example, a flashing blue light mayindicate synching with a patient or clinician device, a green light mayindicate the active mode, and the absence of light may indicate theinactive/standby mode.

U.S. patent application Ser. Nos. 15/077,809 and 15/077,793 and U.S.Provisional Patent Applications Ser. Nos. 62/136,892 and 62/136,925, allof which are incorporated herein by reference, describe additionalfeatures and arrangements that can be incorporated in the wearabledevices and sensor units described herein. These patent applicationsalso describe other wearable or implantable devices that can be used inthe methods and systems described herein.

In some embodiments, a second sensor unit can be used. For example, thesecond sensor unit can be placed on or within the same leg on the otherside of the joint. As another example, a second sensor unit may beplaced on the other leg for use in detecting or observing limp or othergait deficiencies or placed on the torso to detect or observe bodyorientation. A second sensor unit (or more additional sensor units) mayalso be used when two or more replacements are implanted in the body,for example, with multiple joint or vertebra replacements, to detect orobserve, for example, subluxations, changes or defects in posture,scoliosis, or the like.

The two sensor units optionally can communicate or synch with eachother. In at least some embodiments, the two sensor units can sync toeach other and know where each one is in space and their location fromeach other in terms of distance and orientation. As an example, the twosensor units may triangulate their positions using a patient orclinician device. In at least some embodiments, if one of the sensorunits is replaced or removed from its base, the patient device or othersensor unit is advised. When the sensor unit is reattached to its baseor a new sensor unit is attached to the base, the system can determinethe location or distance of the new sensor unit relative to the othersensor unit.

The sensors in the two sensor units can be used to measure flexionangles; range of motion; calculate vectors, angles, rays, planes ordistances; and the like. Temperature sensors on the two sensor units canbe used to determine temperature differences between two portions of thebody. The sensors from the two sensor units can be used to calculateangles or other information that can be used to send signals to thepatient if the patient is exceeding limitations on movement of range ofmovement during physical therapy or rehabilitation.

As indicated above, the sensor processor or sensor communicates with apatient device or clinician device to provide sensor data or informationderived from the sensor data. The patient device can be a dedicateddevice or can be an application on a smartphone, tablet, laptop ordesktop computer, a web or cloud application, or any other suitablearrangement. Communication between an implanted or wearable sensor unitand the patient or clinician device can occur at predetermined times(for example, every 30 minutes or every hour or once a day). In thismanner, the sensor unit can sync with the patient or clinician device.Similarly, the patient device may sync with the clinician device on aregular schedule. In some embodiments, if the sensor unit or patientdevice detects a situation (such as a fall or elevated temperature)where an alert is warranted, the sensor unit or patient device maycommunicate (or attempt to communicate) with the patient device orclinician device, respectively, immediately to provide a warning.

Alternatively or additionally, the communication between the sensor unitand the patient or clinician device can be constant or nearly constant(for example, once every 1, 5, 10, 30, or 60 seconds.) For example, theconstant or near constant communication may be established when thesensor unit determines that the patient is performing exercises or whenthe patient manually actuates a control on the patient device or sensorunit indicating that the patient will commence with exercises orotherwise desires the sensor unit to communicate or sync with thepatient device.

FIGS. 5-16 illustrate screenshots of one embodiment of an application oruser interface for the patient device or clinician device. Theillustrated application or user interface is particularly useful for amobile device such as a smartphone or tablet, but can also be used withother devices such as desktop or laptop computers. FIG. 5 illustratesone embodiment of a patient or clinician profile for the application oruser interface. Elements of this page can include, but are not limitedto, patient or clinician information, controls to input anidentification number or other identification information for a wearabledevice so that the wearable device can be synched or otherwise coupledto the patient or clinician device, controls to input or change apassword or to input or access application settings, a control to accessa calibration program to calibrate the wearable device, controls foraccessing one or more other features or pages, or the like. Otherinformation that might be presented on this or another page can include,but is not limited to, controls for account creation or account login,indication of the status of the wearable device, or controls to accesshelp information; FAQs; photos or videos or text for directions on howto apply the wearable device to the skin of the patient, how to care fora surgical wound, how to perform particular exercises, or how to programor operate the wearable device.

FIG. 6 illustrates another page of the user interface or applicationthat provides information such as steps per day (or number ofrepetitions of an exercise or the like) and a temperature measurement asshown in section 592. The user interface 590 may also include a section594 that shows graphs of the data such as the hourly number of steps, asillustrated in FIG. 6 . The illustrated user interface permits the userto select from other charts such as exercise history (labeled “ROM”),temperature or temperature trends, and number of impacts or shocks tothe sensor module. It will be understood that other measurement orobservations from the sensor described above can be graphed. In at leastsome embodiments, the user may also be able to select the time period ofthe graph to display data in periods of time such as, for example,minutes, hours, days, or weeks.

This user interface can be useful in monitoring patient activity andprogress. The graphs in section 594 may be useful for showing patientexercise history and progress. In some embodiments, the user interfacemay also allow the user to set goals such as, for example, a number ofsteps or a number of exercise repetitions over a particular period (forexample, 1, 2, 4, 6, or 7 hours or 1 day or 1 week). The user interfacemay also display the current status towards attaining those goals. Theuser interface may also highlight notable events, such as, for example,the largest number of steps or exercise repetitions, elevatedtemperature readings, large numbers of impacts or shocks, or the like.The user interface may also highlight the attainment of goals.

FIG. 7 illustrates another page of the user interface or applicationthat displays information related to particular patient measurementsthat can be tracked to monitor rehabilitation or physical therapy. Inthe illustrated page, the patient measurements are flexion and extensionrelated to a patient's knee. These patient measurements can include, butare not limited to, range of motion measurements such as flexion andextension. The page also illustrates a chart 596 tracking the progressof these measurements. The progress may be tracked hourly, daily,weekly, or over any other period of time. In some embodiments, the userinterface or application allows the user to select or change the timeperiod illustrated in the chart. The page in FIG. 7 also providesinformation about other measurements such as percentage of exercisecompletion, skin temperature, number of steps or the like.

FIG. 8 illustrates another page in which the user interface orapplication can be directed to calculate or otherwise determine aparticular measurement. In the illustrated case, the measurement isfemur angle.

FIG. 9 illustrates another page in which the user interface orapplication tracks the daily exercise program. In the illustratedembodiment, the exercises are sitting lift, heel slide (hip and kneeflexion), straight leg raise, and knee to chest. Other exercises caninclude, but are not limited to, standing lift, ankle pump, anklecircle, thigh squeeze (quadriceps set), lying kick (short arcquadriceps), knee bend (sitting knee flexion), prolonged knee stretch,sitting kick (long arc quadriceps), keen straightening stretch, kneedangling/swinging, hamstring set (heel dig), buttocks squeeze (glutealset), walking, or the like. These exercises are directed to kneerehabilitation. Of course, rehabilitation or physical therapy for otherjoints or body regions can include a different set of exercises. Inaddition, the page illustrates the percentage of completion for each setof repetitions (in this case, three sets) that are to be performed bythe patient.

FIG. 10 illustrates yet another page with a single exercise. This pageillustrates the current measurements associated with the exercise (inthis case, flexion and extension). The page also illustrates how theexercise is performed and may include a control for the patient toindicate that the exercise is to be begun. In some embodiments, the pagemay also provide an indication of the number of repetitions (or thenumber of repetitions that are still needed to achieve a repetitiongoal) as the patient exercises. The page may also indicate patientmeasurements based on the exercise (e.g., a current measurement for thelatest repetition or an average measurement for the current set ofrepetitions or a maximum measurement for a set of repetitions) and mayalso indicate a goal for the measurement. This page may include a meterwith bars or the like to indicate what portion of an exercise goal hasbeen met. An indication (such as a bar or the like) may also indicatewhat portion of a range of motion or other therapy goal has been met. Insome embodiments, the page may display an average patient time to therange of motion goal or the like to motivate the patient.

FIG. 11 illustrates a page with controls for accessing videos that canshow the patient how to perform exercises. FIG. 12 illustrates a pagewhere the patient can set reminders to perform an exercise. The patientcan set a time for the reminder and may also set a visual or audiblealarm to remind the patient to exercise at the appointed time.

FIG. 13 illustrates a page with an indication of how far the patient hasprogressed in the physical therapy or rehabilitation. The distance andmilestones included on this indication can be based on time (e.g., daysor weeks) of the rehabilitation; physical measurements (e.g., flexion orextension) towards a final goal for that physical measurement; number ofcompleted repetitions, or completion of, one or more exercises towardsan exercise goal, or the like. As illustrated in FIG. 13 , the page mayalso include a graph of measurements (similar to FIG. 7 ) or number ofrepetitions or a graph of any other pertinent information.

FIG. 14 illustrates a page for a clinician device that indicatesinformation about a group of patients, such as number or percentage ofpatients completing exercise or other goals, number or percentage ofpatients achieving particular range of motion or other measurementgoals, or the like.

FIG. 15 illustrates a page for a patient or clinician device wheresettings can be entered or changed for a patient. Such settings caninclude, for example, which exercises are to be performed, number ofrepetitions for each exercise, number of sets of repetitions per day foreach exercise, number of steps for each day. This page may includecontrols to permit changing these settings. In addition, as illustratedin FIG. 15 , the settings may be related to a particular stage of therehabilitation or physical therapy. The page may allow for togglingbetween different stages sot that settings can be viewed, entered, orchanged for that stage. Another page for a patient or clinician devicemay display the actual results achieved by the patient and may comparethose to the settings or goals entered for that patient.

FIG. 22 illustrates one embodiment of a method for displayinginformation requested by the patient. In step 2202, the patient devicereceives input from the patient for display of exercise or otherinformation. In step 2204, the patient device displays the requestedinformation. For example, the requested information may be a graphicalrepresentation of the exercise and a user control which, when actuatedby the user, indicates that the user is performing the exercise. Oneexample of such requested information is illustrated in FIG. 10 . Therequested information may be a count of repetitions of the exercisebeing performed or a summary of a plurality of exercises indicating anumber of repetitions performed for each exercise over a period of time.Examples of such requested information are presented in FIGS. 7, 9, 13,and 14 . The requested information may be a progress report for a rangeof motion measurement or a graph of values for the range of motionmeasurement obtained over a period of time. Examples of such requestedinformation are presented in FIGS. 7, 13, and 14 . The requestedinformation may be a representation of a pathway to a goal for the rangeof motion measurement with an indication of current progress of thepatient toward that goal as illustrated, for example, in FIG. 13 .

FIG. 16 illustrates another page in which the patient is directed totake a photograph or video of their knee or other wound site or physicaltherapy site using a camera on the patient device or other device. Thepage may direct the user how to frame the photo or video. In at leastsome embodiments, the photo or video may be sent to the clinician deviceor other device through the network (see, FIG. 1 ) or by other methods.A clinician may use the photo or video to assess the wound or physicaltherapy site. In some embodiments, the patient device may request avideo be taken of the patient performing an exercise. The video may beprovided to the patient device or clinician device to assess or viewperformance of the exercise. For example, a clinician may assess whetherthe patient is performing the exercise correctly or may assess progressin physical therapy or rehabilitation by observation of the exercise.

In some embodiments, the patient device is configured and arranged toperform pigment analysis or other wound analysis on the knee using thephoto or video. For example, the patient device may compare skin pigmentat the wound site with skin pigment near the wound site to identifyinfection (for example, superficial wound infection or deep woundinfection), rash, discoloration, or other issues. In at least someembodiments, the pigment or other wound analysis may be combined withskin temperature information to assess infection (for example,superficial wound infection or deep wound infection), rash,discoloration, or other issues. If the analysis indicates a potential oractual issue, the patient device may provide a visual or audible warningto the patient and may also send an alert to the clinician device. Inother embodiments, the pigment or other wound analysis (with or withoutskin temperature information) may be performed by the clinician deviceor other device instead of (or in addition to) the patient device. Thepatient device or clinician device may include white balancing or lightcompensating algorithms to assess the photos or videos. The patientdevice may also include a calibration tool to facilitate calibrating thelight and other aspects of the photo or video.

In some embodiments, instead of or in addition to taking a photo orvideo, the patient device may display the region at which the camera ispointed for viewing by the patient. This displayed area, or the photo orvideo, may be altered to overlay lines or graphics that correspond topatient anatomy. These lines or graphics may move as the patient's legor other body part move. In some embodiments, patient measurements, suchas flexion or extension or other range of motion measurements, may becalculated during the movement and displayed on the patient device;changing as the patient limb moves.

FIG. 20 describes one embodiment of a method of taking a photograph orvideo of a site on the patient. In step 2002, the patient device (orclinician or other device or person) directs the patient to takephotograph or video of the site (such as the site of physical therapy ora surgical or wound site.) In step 2004, the patient takes thephotograph or video using the camera of the patient device (or a cameraof another device) and the photograph or video is stored. In someembodiments, the photograph or video is sent to the clinician device orother device, in optional step 2006. In step 2008, analysis can beperformed on the photograph or video. The analysis can be performed bythe patient device, clinician device or any other suitable device. Forexample, a pigment analysis can be performed or analysis related toexercises or range of motion measurements can be performed. In someembodiments, graphical indicia, such as lines or angles, can besuperimposed on the photograph or video based on the analysis.

A patient device, user interface, or application may include otherfeatures. For example, the patient device, user interface, orapplication may include controls for a patient to enter information orratings about their experience in the hospital, their experience duringrehabilitation, how connected the patient fees during the rehabilitationprocess, whether the patient would recommend the wearable device orother aspects of the treatment to family or friends, or the like. Thepatient device, user interface, or application may include controls forentering a rating related to pain or other clinical aspects. Forexample, the patient may enter a pain score based on a scale provided onthe device. Other scores that may be entered by the patient, clinician,or others may be based on scores such as a Knee Society score, a NewKnee Society score, other society score, KOSS or PROM (patient reportedoutcome measurements), oxford knee score, or Womack, or any othersuitable score or rating.

FIG. 21 illustrates one embodiment of a method of inputting a painscore. In step 2102, the patient device directs the user to input a painscore and the device receives the pain score. In step 2104, the painscore is sent to the clinician device or other device.

The patient device, user interface, or application may include controlsto add friends, create a friend network, send messages to friends, sendprogress updates or other exercise information to friends or others, orthe like. Some of the friends may be other patients, and the patientdevice, user interface, or application may display comparisons ofprogress with friends, allow issuance of a challenge to a friend,provide a control to send encouragement to a friend, or other socialcontrols or interaction capabilities. In addition, another applicationmay be available to family, friends, and associates of the patient. Thisapplication may allow the user to send encouragement or messages to thepatient and may also display progress updates or other exerciseinformation that the patient has permitted. These applications andfeatures can be helpful in encouraging the patient to continue theircommitment to the physical therapy or rehabilitation goals andobjectives.

FIG. 23 illustrates one embodiment of a method for including friends inthe physical therapy. In step 2302, the patient is directed to enter oneor more friends into the patient device. In step 2304, a connectionmessage is sent to the one or more friends to connect them to thepatient's friend network. In step 2306, the patient receives a messageof encouragement from at least one of the one or more friends. Inoptional step 2308, the patient sends a message, challenge, or progressreport to at least one of the one or more friends. The progress reportcan include, for example, an indication of progress by the patienttoward at least one physical therapy goal, an indication of performanceof the at least one physical therapy exercise by the patient, or anindication of performance of the at least one physical therapy exerciseby at least one of the one or more friends, or the like or anycombination thereof.

FIG. 17 illustrates a user interface 690 that may be suitable for acomputer or web interface. The illustrated user interface includes aregion 692 displaying the results of temperature measurements 692 a,step measurements 692 b, range of motion tests 692 c, specific exercisesand tests 692 d, and adverse events 692 e. These results may includenumerical information and graphical information. These results may alsoillustrate graphically or numerically the degree of success inperforming exercises (see, for example, region 692 d) and may alsoillustrate the degree of compliance with rehabilitation activities (suchas the number of exercise repetitions performed). Such an arrangement ofinformation can facilitate monitoring or patient progress,identification of progress or lack of progress, identification ofconcerns (such as elevated temperature or elevated number of shocks orimpacts), and the like.

Other information that can be displayed in one or more pages on the userinterface can be include any suitable patient rehabilitation progressdata include baselines and progress over time. For example, theinformation can include baseline range of motion information forexercises such as a sitting leg lift, heel slide, standing lift, pronelift, or the like. The information may also include current range ofmotion information for these exercises. The information may also includestep analysis information including, but not limited to, pre-operationand post-operation average cadence, maximum cadence, stride angle, aswell as time spent walking, biking, running, or in sedentary activities.Additional information can include skin temperature, ambienttemperature, and trends in temperature. The user interface may alsoprovide information about how many times or how often the patient fallsor other notable events. The user interface may provide information fromGPS readings from the wearable device or patient device to assessbaseline activity, current activity, general activity after surgery orphysical therapy or the like.

The user interface of a clinician device may also be used to conductin-office range of motion tests. The clinician device or patient devicemay be used to create video of range of motion exercises.

FIG. 18 illustrates a user interface 790 for a clinician to monitormultiple patients. The region 792 includes information such as patientname, surgery date, sensor date and results of tests 792 a, number ofadverse events, location of the orthopedic implant, and the like. Theclinician may also track number of surgeries 794, rate of successfulrehabilitation 796, and other suitable information such as, for example,total number of surgeries (for example, total number of kneereplacements), average time to reach a particular rehabilitation outcome(for example, average time to reach specified range of motion), and thelike.

FIG. 19 illustrates another user interface for a clinician to monitorpatients. The region 1592 includes information such as patient name,gender, surgery date, days post operation, measured or trendingtemperature, range of motion measure, activity, number of steps, notableevents, implant site, wearable device status, and the like. Theclinician may also track number of successful rehabilitations 894, rangeof motion achieved over time for a group of patients 896, and othersuitable information. Controls may also be provided to access individualpatient records 898 or access patient alerts 899.

In at least some embodiments, the applications or user interfacesdescribed herein can be web or application interfaces that areaccessible when the patient device or clinician device accesses a serverfor a content provider. In at least some embodiments, the server orother servers or memory storage devices can store information for theweb interface and may also store patient-specific information includingpatient identification data, sensor data or information derived fromsensor data, patient or clinician comments or the like, or any othersuitable data. In at least some embodiments, the patient-specificinformation can be accessed from the patient device, clinician device orother device which, in some embodiments, may require providingcredentials (e.g., username or password or both) to access theinformation.

Additional user interfaces and methods of calculating or otherwisedetermining information relating to the physical therapy,rehabilitation, or status of the patient are described in U.S. patentapplication Ser. Nos. 15/422,312 and 15/422,299, both of which werefiled on Feb. 1, 2017 and incorporated herein by reference.

The methods and systems described herein may be embodied in manydifferent forms and should not be construed as limited to theembodiments set forth herein. Accordingly, the methods and systemsdescribed herein may take the form of an entirely hardware embodiment,an entirely software embodiment or an embodiment combining software andhardware aspects. Systems referenced herein typically include memory andtypically include methods for communication with other devices includingmobile devices. Methods of communication can include both wired andwireless (e.g., RF, optical, or infrared) communications methods andsuch methods provide another type of computer readable media; namelycommunication media. Wired communication can include communication overa twisted pair, coaxial cable, fiber optics, wave guides, or the like,or any combination thereof. Wireless communication can include RF,infrared, acoustic, near field communication, Bluetooth™, or the like,or any combination thereof.

It will be understood that each block of the flowchart illustrations,and combinations of blocks in the flowchart illustrations and methodsdisclosed herein, can be implemented by computer program instructions.These program instructions may be provided to a processor to produce amachine, such that the instructions, which execute on the processor,create means for implementing the actions specified in the flowchartblock or blocks disclosed herein. The computer program instructions maybe executed by a processor to cause a series of operational steps to beperformed by the processor to produce a computer implemented process.The computer program instructions may also cause at least some of theoperational steps to be performed in parallel. Moreover, some of thesteps may also be performed across more than one processor, such asmight arise in a multi-processor computer system. In addition, one ormore processes may also be performed concurrently with other processes,or even in a different sequence than illustrated without departing fromthe scope or spirit of the invention.

The computer program instructions can be stored on any suitablecomputer-readable medium including, but not limited to, RAM, ROM,EEPROM, flash memory or other memory technology, CD-ROM, digitalversatile disks (“DVD”) or other optical storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which can be used to store the desired informationand which can be accessed by a computer.

The above specification provides a description of the manufacture anduse of the invention. Since many embodiments of the invention can bemade without departing from the spirit and scope of the invention, theinvention also resides in the claims hereinafter appended.

What is claimed as new and desired to be protected by Letters Patent ofthe United States is:
 1. A system for monitoring a patient, the systemcomprising: at least one sensor unit disposed on or within the patient;a plurality of accelerometers distributed over the at least one sensorunit; a patient device configured and arranged for communication withthe at least one sensor unit, the patient device comprising a display, amemory, and a processor coupled to the display, and memory, the memoryhaving instructions stored thereon, wherein the processor executes theinstruction to perform actions, the actions comprising: a) receiving arange of motion goal; b) receiving acceleration measurements from atleast two of the accelerometers; c) determining a range of motion of ajoint using the acceleration measurements; d) determining a center ofrotation around the joint; e) repeating at least steps b) and c) atleast one time; and f) displaying, on the display, a chart trackingprogress in the range of motion over time and an indication of whatportion of the range of motion goal has been met.
 2. The system of claim1, wherein the at least one sensor unit comprises at least two sensorunits.
 3. The system of claim 2, wherein at least one of theaccelerometers is disposed within each of the at least two sensor units.4. The system of claim 1, wherein determining the range of motioncomprises determining a flexion of the joint.
 5. The system of claim 1,wherein determining the range of motion comprises determining anextension of the joint.
 6. The system of claim 1, wherein the displayingfurther comprises displaying an average patient time to the range ofmotion goal.
 7. The system of claim 1, wherein the receiving comprisesreceiving the range of motion goal for a specified exercise.
 8. Thesystem of claim 7, wherein determining the range of motion comprisesdetermining the range of motion as the patient performs the specifiedexercise.
 9. The system of claim 8, wherein the actions further comprisedisplaying, during performance of the specified exercise, either acurrent value or a maximum achieved value of the range of motion for thespecified exercise.
 10. The system of claim 7, wherein the specifiedexercise is selected from sitting leg lift, heel slide, standing lift,or prone lift.
 11. The system of claim 7, wherein the actions furthercomprise displaying a number of repetitions performed for the specifiedexercise.
 12. The system of claim 7, wherein the actions furthercomprise displaying a level of compliance for performance of thespecified exercise.
 13. The system of claim 1, wherein the patientdevice further comprises a camera.
 14. The system of claim 13, whereinthe actions further comprise directing the patient to take a photographof the joint using the camera.
 15. The system of claim 14, wherein theactions further comprise displaying the photograph with graphicalindicia on the photograph illustrating the range of motion.
 16. A methodfor monitoring a patient, the method comprising: a) selecting a range ofmotion goal; b) obtaining acceleration measurements from at least twoaccelerometers distributed over one or more sensor units disposed on orwithin the patient; c) determining a range of motion of a joint usingthe acceleration measurements; d) determining a center of rotationaround the joint; e) repeating at least steps b) and c) at least onetime; and f) displaying, on a display, a chart tracking progress in therange of motion over time and an indication of what portion of the rangeof motion goal has been met.
 17. The method of claim 1, wherein thedisplaying further comprises displaying an average patient time to therange of motion goal.
 18. The method of claim 1, wherein the selectingcomprises selecting the range of motion goal for a specified exercise.19. The method of claim 18, further comprising displaying a number ofrepetitions performed for the specified exercise.
 20. The method ofclaim 18, further comprising displaying a level of compliance forperformance of the specified exercise.